Provider Demographics
NPI:1801847942
Name:GROSSMAN, ROBERT B (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:B
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1131 BROAD ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4329
Mailing Address - Country:US
Mailing Address - Phone:732-889-3800
Mailing Address - Fax:732-542-4847
Practice Address - Street 1:1131 BROAD ST
Practice Address - Street 2:SUITE 104
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4329
Practice Address - Country:US
Practice Address - Phone:732-889-3800
Practice Address - Fax:732-542-4847
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA03307600207XX0005X
NJMA33076207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2519305Medicaid
NJC56958Medicare UPIN
NJC56958Medicare UPIN